If Nothing is Certain But Death and Taxes, Why Do So Few Americans Prepare for the End of Life?

Of the roughly 2 million deaths in the United States each year, the vast majority strike older adults suffering from long-term illnesses. Dying older adults who do not make plans for their end-of-life medical care often are subject to futile, costly, and potentially distressing life-extending treatments. Although Americans have the opportunity to prepare for end of life health care via the use of advance directives, relatively few take these steps to ensure decision-making autonomy. In this talk, I will present data from two samples &#8211;healthy, white adults in their early 60s (Wisconsin Longitudinal Study), and terminally ill black, white and Hispanic adults in later life (New Jersey End of Life Study) &#8211; to document the psychosocial, religious, and structural influences on end-of-life preparations and preferences.